FACTORS ASSOCIATED WITH PERSISTENCE OF PAIN IN LUMBAR STENOSIS SURGERY

ABSTRACT Objective: The objective of this study was to determine the factors associated with the persistence of pain in patients operated on for lumbar stenosis. Method: One hundred and fifty-three patients were studied, divided into two groups: 1) Patients with persistent pain in varying degrees, 2) Patients without pain. Age, sex, affected levels, comorbidities, surgical risk, and type of surgical procedure were evaluated. Results: There were 108 patients in the group with pain and 45 in the group without pain. In the group with pain, there were 28 patients with diabetes mellitus, 31 smokers, and 28 alcohol-dependent patients, with a significant difference of p = 0.001 and an RR = 1.1. A simple widening procedure was performed in 48 patients in the group with pain and 12 patients in the group without pain, with RR = 0.8, and widening plus instrumentation was performed in 7 patients in both the with and without pain groups. Conclusion: The indication of a surgical procedure in patients with spinal stenosis must take many factors into account in addition to clinical factors and the segments affected, since these factors impact patient prognosis. In the multivariate analysis, the variable most closely associated with persistent pain was the procedure performed. Level of Evidence III; Case-control study.g

摘要
研究目的：本研究旨在明确腰椎管狭窄症（lumbar stenosis）术后患者持续性疼痛的相关影响因素。
研究方法：本研究共纳入153例腰椎管狭窄症术后患者，分为两组：① 存在不同程度持续性疼痛的患者组；② 无疼痛症状的患者组。对两组患者的年龄、性别、受累节段、合并症、手术风险及手术方式进行评估分析。
研究结果：疼痛持续组共108例患者，无痛组共45例患者。疼痛持续组中，合并糖尿病者28例、吸烟者31例、酒精依赖者28例，组间差异具有统计学意义（p=0.001，相对危险度（Relative Risk, RR）=1.1）。疼痛持续组有48例患者接受单纯减压扩管手术，无痛组有12例接受该术式（RR=0.8）；两组各有7例患者接受减压扩管联合内固定手术。
研究结论：腰椎管狭窄症患者的手术指征制定，除需考量临床因素与受累节段外，还需综合诸多其他因素，因上述因素会对患者预后产生影响。多因素分析（multivariate analysis）结果显示，与术后持续性疼痛关联性最强的变量为所实施的手术方式。本研究为病例对照研究（case-control study），证据等级为III级。